The present invention relates to the use of ketoconazole or molecules resembling ketoconazole but with some side-chains, not affecting the biological activity compared to ketoconazole, changed for manufacturing drugs for treatment of diabetes mellitus type II.
The drug ketoconazole (Trade name Fungora(trademark)) is a well-documented drug for treatment of fungal infections. The process of making ketoconazole is well known and described. In this invention Fungoral(trademark) capsules aimed at oral administration should be used. This means that Fungoral(trademark) should be administered the same way (oral) and in the same composition that is already well-known on the market for treatment of fungal infections the oral route. Therefor it is not considered necessary to further describe the process of making Fungora(trademark). For the same reason it is not considered necessary to give a full, clear, concise and exact term of this drug, since it is already well-known for persons skilled in the art of medicine.
The drug comprising ketoconazole (Trade name Fungoral(trademark)) and chemically closely related substances, the mode of operation of which is to influence the normal cortisol synthesis in the adrenal glands in such a way that the production of biologically perfectly acting cortisol is partly inhibited, is intended to be used for medical treatment of diabetes mellitus type II in men and women as well as for counter-acting the risk factors which are parts of the Metabolic Syndrome (also known as xe2x80x9cthe deadly quartetxe2x80x9d or xe2x80x9cSyndrome Xxe2x80x9d or the xe2x80x9cInsulin Resistance Syndromexe2x80x9d), which is characterised by an accumulation of risk factors for cardiovascular disease, stroke and diabetes mellitus type II, i.e. insulin resistance, hyperinsulinemia, abdominal obesity, (caused by an accumulation of intra-abdominal fat), elevated serum lipids, and raised blood pressure, as well as reducing the risk of development of these diseases.
In this new invention ketoconazole small be administered the oral route in doses of 100-800 mg daily. The drug can be administered once or several times daily. At present a dose of 400 mg administered in the evening has been proven to be the best mode. However, we also claim that administration at other points of time, and in other doses (100-800 mg) can be equally effective.
Since ketoconazole is also inhibiting the normal production of testosterone in men, it is possible that this sex needs a certain amount of testosterone supplementation when treated with ketoconazole, to have an optimal effect of the treatment.
We have investigated a group of people with diabetes mellitus type II. They have been treated with ketoconazole during 2 and 6 weeks, respectively. Investigations before and after treatment have shown a decrease in blood glucose measured either in the fasting state or at 2 hours after an intraveneus glucose infusion, and most important, a remarkable improvement of insulin sensitivity. More exact data from these studies are given in the tests described below.
Since a decreased insulin sensitivity is a central part of xe2x80x9cThe metabolic syndromexe2x80x9d, also known as xe2x80x9cThe deadly quartetxe2x80x9d, xe2x80x9cSyndrome Xxe2x80x9d or the xe2x80x9cInsulin Resistance Syndromexe2x80x9d we also claim that fungoral treatment to people with risk factors according to this syndrome should be expected to be effective also for treatment of these specific risk factors (abdominal obesity, hypertension, elevated blood lipids) as well as for decreasing the risk for diseases caused by these risk factors (Cardiovascular disease such as coronary artery disease, other arteriosclerotic manifestations including stroke).
The mechanism of the action of ketoconazole is that the substance influence the cortisol synthesis of the adrenal glands in such a way that a sub-fraction of a biologically non-perfect substance similar to cortisol, so called xe2x80x9ccrippled cortisolxe2x80x9d, is formed instead of the normal cortisol molecule.
The cortisol antagonistic effect of the drug is considered to have a central importance for the positive effects on the risk factors mentioned above, decreasing the metabolic activity of fat inside the abdominal cavity, which in turn leads to a decreased fat infiltration of the liver, improving the glucose homeostasis over the liver and peripherally in the tissues in turn leading to improvement of diabetes mellitus type II (decreasing blood glucose and increasing insulin sensitivity), reducing the serum lipids through improvement of the regulating mechanisms in the liver and also inhibiting cholesterol synthesis by a direct effect on the adrenal glands. A positive effect on the blood pressure can also be expected via the cortisol-antagonistic effect.